Enrollment

Date:

Address (Street Name):

Address (City, State, Zip):

Phone Number: *

Email Address: *

Date of Birth (MM/DD/YYYY):

Gender:

Ethnicity (African American / Asian / Hispanic / Native American / South Asian / Other):

Parent/Guardian Name (Last, First, Middle):

Address (Street Name):

Address (City, State, Zip):

Phone Number:

Email Address:

Family Size (Adults and children):

Household Income (less than $20,000 / $20,001-$32,000 / $32,001-$44,000 / $44,001-$56,000 / $56,001-$68,000 / more than $80,000):

Grade Attending for Next School Year:

Current GPA:

HIGH SCHOOL Name & Address:

Dates (from – to):

Courses Studied:

GPA:

Graduation Date:

MIDDLE SCHOOL Name & Address:

Dates (from – to):

Courses Studied:

GPA:

Graduation Date:

ELEMENTARY SCHOOL Name & Address:

Dates (from – to):

Courses Studied:

GPA:

Graduation Date:

Current Math Class (ex. Algebra, Geometry):

Next School Year Math Class:

Current Science Class (ex. Biology, Chemistry):

Next School Year Science Class:

School Activities (Athletics / Drama Club / Student Office Held / School Paper / Yearbook / Other):

Awards:

Hobbies:

Interests (Insert all that apply): (Computer Science / Education / Engineering / Math / Medicine / Physics / Other):

What school subjects are you most interested in? (Math, Science, English):

What are your plans after high school?:

How did you learn of FAME? (Counselor / Teacher / Family/Friend / Website / Other):

Why are you interested in attending the program?:

Type the text shown: *





Send me a copy